"Part of the theory for extending the program is that uninsured people are most likely to use high cost emergency rooms for health care and wait until health crises before seeking help. Ultimately taxpayers and insurance premium payers pick up the tab anyway, but for high cost and inefficient care. The goal is to get them some kind of coverage and, if possible, preventive and regular health care to reduce costs."

There are several problems with this argument. So many problems, in fact, it is safe to say that expanding Medicaid to cover Nebraskans who are currently uninsured will do little or nothing to realize cost savings. It is more likely, in fact, to move the cost figures in the opposite direction.

First, the underlying assumption about uninsured people -- that they are the group most likely to seek treatment for non-emergency conditions at hospital emergency centers -- is inaccurate. Surveys in 2007, 2010, and 2011 published by the Centers for Disease Control (CDC) showed that about 20% of U.S. adults had used the emergency room in the past 12 months, with usage most common for those with public health insurance and living outside a metropolitan statistical area (MSA).2 According to the study using 2007 data, "So-called frequent fliers, a term emergency department (ED) personnel sometimes use to describe patients ...continue

Public health insurance MEANS Medicaid and Medicare, folks. So, tell me again: How is expanding Medicaid going to REDUCE the numbers of Nebraskans visiting emergency rooms for routine care and, as a result, achieve all those cost savings for the state's taxpayers and private insurance premium payers?

Also, did you notice the comment about “living outside a metropolitan statistical area (MSA)”? Most of the State of Nebraska is outside an MSA. And even though those portions of the state tend to be sparsely-populated, state residents who currently participate in Medicaid are essentially evenly distributed between metro and rural counties, which is apparently an unusual statistical pattern. In short, Nebraska's statistical profile of the “typical” Medicaid recipient is weighted more heavily than in most states toward those who are more likely to use the emergency room for non-emergency care (i.e., those who live outside an MSA).

Second, where will all these new Medicaid recipients find doctors to provide that “preventive and regular health care” the senators anticipate LB577 will secure for them? A few facts to digest:

Finally, there's no disincentive that would cause Medicaid patients to avoid emergency rooms when their problem is not urgent. They don't bear any of the additional costs associated with such “inefficient” care. With no skin in the game, it matters very little to them where they receive care, so long as they can avail themselves of it whenever they need or want it.

"When government underpays, providers shift their costs to private insurers and cash customers.

"Mrs. Clinton never mentions how Medicare shifts costs to private payers. Instead, she points to cost-shifting created by unpaid treatment for the poor. But doctor and hospital bills have always recovered the cost of unpaid treatment. What's new is cost shifting by government.

"From 1985 to 1989, unpaid hospital care grew slightly, from 5.5% to 6.0% of billing. But government underpayment shot from 0.6% to 5.0% -- the same years private insurance premiums started skyrocketing.

"Obviously, runaway private insurance costs are not caused by cost shifts from the uninsured poor. That shift has always existed, as a bad debt, and has remained fairly constant. Excessive medical cost inflation is caused by new and growing shifts from Medicare and Medicaid. Politicians have promised more than they can pay for with taxes. So they force private insurers to pick up the tab.

"Eventually, you and I pay anyhow. One big difference: if Medicaid and Medicare were fully funded by taxes, we could all see government's failures. Shift the costs elsewhere, and private insurance looks like the villain." (emphasis added)

It's really amazing how long the answer has been known but remains unacknowledged and unaccepted by the Progressives among us. They close their eyes, stuff their fingers in their ears, and loudly chant La-La-La as they march us toward universal, single-payer, government health care and, shortly thereafter, off the fiscal cliff. The co-sponsors of LB577 are clearly the Kings -- and Queens -- of Wishful Thinking.

This article series is about Nebraska’s Medicaid program legislation introduced in the Unicameral aimed at expanding it, and the many reasons why expansion is an uncommonly bad idea.
This first grouping of articles don't necessarily have to be read in order as they are research, principle, and policy focused:

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Some of the conflict has played out in the press. Governor Heineman did not take kindly to the Unicameral’s override of his veto of LB599, the bill to extend Medicaid coverage to pregnant illegal aliens. In denouncing the override, Heineman recommended Nebraskans vote down a measure that would have given the state senators a pay raise, saying the senators did not deserve a raise because of their decision on LB599. In response, Senator Bob Krist took to the pages of the Lincoln Journal Star to decry Heineman’s actions, claiming Heineman had essentially thrown the members of the legislature under the bus.